Abstract

Background and aim. The Council of the European Union has recommended implementation of national population-based screening programmes for breast, cervical and colorectal cancer. In Estonia, screening programmes have been introduced for breast (since 2004), cervical (2006), and colorectal cancer (2016). However, previous research has questioned the effectiveness of Estonian programmes. The aim was to evaluate the process and the outcome indicators, as well as the implementation of cancer screening in Estonia, through analysing participation in screening and changes in stage distribution along with long-term incidence and mortality trends.
Material and methods. Data on participation in screening was drawn from the Estonian Cancer Screening Registry (2015–2020). Incidence trends for breast, cervical and colorectal cancer were examined using Estonian Cancer Registry data (1968–2018). The data for the TNM stage was also obtained from the Cancer Registry. Mortality trends were analysed using data from the Estonian Causes of Death Registry and the WHO database. Joinpoint regression analysis was performed to calculate annual percentage change (APC) for incidence and mortality trends.
Results. Screening participation did not exceed 60% for breast and female colorectal cancer and 50% for cervical and male colorectal cancer. In 2020, participation dropped 3–4 percentage points for all screening programmes.

Age-standardized breast cancer mortality has decreased since 1997 (APC -1.9), and a decline is evident in all age groups except for 70+. The proportion of breast cancer cases diagnosed at stage I has reached 31% of all cases and 39% of cases in the screening age group. During 2015–2018, 20% of all cases and 49% of cases in the screening age
group were diagnosed at screening. Within the screening age group, the proportion of stage I cases was 49% among those detected at screening and 30% among the cases detected otherwise.

The incidence of age-standardized cervical cancer has decreased since 2013 (APC 6.8). A significant decline was seen in the age groups 40–49 years (since 2009) and 60–69 years (since 2012).

The incidence of colorectal cancer has been continuously rising in all age groups. The proportion of stage IV at diagnosis has remained around 25%.

Conclusions. Despite low participation, screening programmes have helped prevent new cancer cases and reduce cancer deaths in Estonia. Unfortunately, the drop in participation in screening in 2020 may impact these trends. Therefore, it is crucial to increasingly focus on improving the coverage and quality of cancer screening in Estonia.